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General Community Health Volunteers Training Facilitator Guide (Community Based Management of Childhood illness) Ministry of Health and Social welfare Liberia February, 2012 TRAINING CURRICULUM OVERVIEW Purpose This facilitator guide is designed to guide trainers, supervisor and partner organization staff in training general Community Health Volunteers (gCHVs) in community case management of three childhood diseases: diarrhea, malaria, and pneumonia. It incorporates and builds on the pilot’s experience and RBHS internal evaluation results 2010. Course Description This guide provides guidance to facilitators of general community health volunteers (gCHVs) to train semi- literate and illiterate volunteers. Trainers are trained for two weeks in training methodologies, the three diseases, and Health Information System (HMIS). The step down training is done in phases. Phase 1 is three days training of gCHVs on diarrhea, recording and reporting of data. gCHVs are supervised and

monitored for at least months and based on gCHVs performance, phase two training is organized on Acute Respiratory Infection (ARI), health information system ,recording and reporting. Similarly, gCHVs are supervised and monitored for at least a month and based on performance phase three training is organized and conducted for a period of five days on Malaria, health information system recording and reporting of data. Course Goal    To provide gCHVs with knowledge and skills needed for identification and management of diarrhea, Malaria and pneumonia. To provide the gCHVs with knowledge and skills needed for counselling of < 5 childhood illness. To provide the gCHVs with the knowledge and skills needed for recording and reporting of the activities performed. gCHVs Learning Objectives 1  This curriculum seeks to help CCM trainers and supervisors prepare gCHVs to perform a specific set of tasks:  Identify signs of common childhood illness in children under five.

 Decide whether to refer children to a health facility or to help families treat their children at home.  For children who can be treated at home, help families provide basic home care to children with malaria, diarrhea and pneumonia.  Follow up the child’s illness with the caregiver General Community Health Volunteers Training Facilitators Guide Each session also has its own, specific learning objectives. TRAINING PREPARATION The facilitators that will train the gCHVs should know that careful planning is important. This should start several weeks before the training workshop. Use the following list as your guide as you plan the workshop: 1. Initial Planning  Establishing Objectives:  Determine intended audience and establish criteria for participants.  Know the training needs of the participants.  Develop a budget for the training.  Identify and contact facilitators (including County CHV focal person, community health service supervisors

(CHSS), partner supervisors and NGO staff as appropriate) and other support for particular sessions.  Know the facilitators’ availability, approach, knowledge about the training topics, their communication skills, and abilities in training a large group of participants. 2. Logistics:  Decide on the training date and venue. This should be agreeable with the participants and the facilitators.  Determine the cost per participant with regard to food, lodging, transportation, and materials.  Reserve the training venue and make it as conducive to learning (i.e well-lit, good ventilation, not noisy) as possible. 3. Identification of Participants and Resource Persons:  Ensure attendance of your participants either by direct contact or through letters of invitation.  Ensure also that the participants are followed-up.  If there is a need for resource persons for handling or facilitating any topics, then make a listing of possible persons to invite prior to

final selection. The list will be narrowed down depending on their availability, eagerness to provide technical assistance, their fee and the comfort level of the facilitators with the resource persons.  Email or send letters also to the selected resource people. Be sure to inform them, both personally and through the letter of invitation, about the goals and objectives of the training, as well as the specifics of what will be expected of them. 4. Preparation and Review of the Curriculum:  Review and adapt as necessary the methodologies and activities of the training sessions.  Determine documents to use based on the training needs of the participants. General Community Health Volunteers Training Facilitators’ Guide 2 5. Preparation of Materials and Equipment:  Adapt as necessary, photocopy, and otherwise acquire any handouts, notebooks, video, or reference materials for training use or distribution.  Prepare flipchart, marker pens, pencils, pens, easel,

board, board markers and many others that you may need. Prepare materials that are applicable and most suited to the circumstance of your training venue. Reminders and Pointers for the Facilitators: The following are included to help trainers conduct this training more effectively. 1. Facilitators should have undergone a ‘Training of Trainers on Community Case Management by Community- Health Service Division of the ministry of health and other appropriate partners. 2. Read all parts of this training curriculum carefully before beginning 3. Check that all materials needed to complete an exercise are ready Follow or adapt the ‘Steps’ described for each exercise. 4. Give clear instructions to the participants, including how much time they have to complete a specific activity. 5. Remember to close each session with a recap of key points 6. Preview key points at the beginning First impressions and setting expectations are important. Explain to the participants the purpose of the

exercises included in that session. 7. Use practical exercises (as contained in this guide) Give participants plenty of handson experience 8. The content must be meaningful and worthwhile to the participant Help them identify their need to be part of the sessions/activities. 9. Use examples, exercises, discussions, etc to reinforce what has been learned 10. Ask for feedback and verify understanding by asking questions Provide praise and constructive criticism. Through feedback, the trainer comes to know if the participants are learning appropriately. Positive reinforcement increases probability of learning 11. Ask participants what they think of the workshop Use this feedback to improve your training style as well as the workshop content and flow. 12. Engage multiple senses to enhance learning Minimize the use of lecture Show as well as tell. Bring out what participants already know or can figure out Encourage discussion and provide examples. Most importantly, allow participants to

practice what they are learning. 13. Use appropriate humor Try to reduce the stress associated with learning Providing participatory learning exercises that are fun and simple and yet full of learning can help. 14. Training must be relevant to participants’ needs and linked to information that is known or situations that are familiar. 15. The more often information is repeated, the more likely it will be remembered, especially if it is repeated in a variety of ways. 3 General Community Health Volunteers Training Facilitators Guide Training/Learning Methods Self learning/reading Demonstration and returned demonstration Illustrated picture written text and group discussions Individual and group exercise Role Plays/ Games for learning Simulated Practice for counting respiratory rate (RR), giving Cotrimoxazole, ORS, Zinc and ACT and facilitate referral for fever with danger signs.  Practical exercises in wall-chart for practice in filling up the registers      

Case scenario, stories Training Materials This course is designed to be used with the following materials: 1. Training manual 2. Facilitators Guide 3. Classification card 4. Treatment card 5. Flip chart 6. Assorted marker, Pen, Pencil 7. Cotrimoxazole 240mg, 8. ACT paediatric tab 9. ORS and Zinc 10. CHV treatment register, referral form, 11. Ledger guide 12. HMIS, treatment ledger and monthly reporting form 13. Respiratory timer 14. Visual aids GCHV/Trainers Selection Criteria 1. Must be professional health workers such as environmental health technicians (EHT), certified midwife (CM), physician assistance (PA), register nurse (RN) and Licensed practical nurse(LPN) 2. Must be a CHVs supervisor of county ,district, health facility Training Site Selection Criteria The training site should be place where an adequate number of < 5 cases can be seen. Ideally the location should be convenient to all the gCHVs preferably the health facility. General Community Health Volunteers Training

Facilitators’ Guide 4 Method of Evaluation At the end of each session, the facilitator should conduct:  Drills  exercise  Role Play  Case Studies  Demonstrations Course Duration Three days for Diarrhea and ARI and five days for Malaria Suggested Course Composition     20 GCHVs in a batch. Each group will have two to three trainers/facilitators Citation for training- Inform trainees two to three weeks ahead of time to enable them prepare adequately for the training. Preparation for the training o -Prepare budget and ensure it is approved before you send out citation o Gather all workshop material- Participant manual, Job aid, referral form, recording ledgers including treatment and HMIS register and reporting forms Needed drugs and supplies- Zinc and ORS for diarrhea training, cotrimoxazole 240mg and paracetatmol 100mg for ARI, RDT, Anti malaria drugs; paracetatmol 100mg for Malaria training, respiratory timers for AIR not waist watch or clock. 5

General Community Health Volunteers Training Facilitators Guide 1. FACILITATION TECHNIQUES A. Techniques for Motivating gCHVs Encourage Interaction 1. During the first day, you will talk individually with each gCHV several times (for example, during individual feedback). If you are friendly and helpful during these first interactions, it is likely that the gCHVs (a) will overcome their shyness; (b) will realize that you want to talk with them; and (c) will interact with you more openly and productively throughout the course. 2. Look carefully at each gCHVs work Check to see if gCHV are having any problems, even if they do not ask for help. If you show interest and give each gCHV undivided attention, the gCHVs will feel more compelled to do the work. Also, if the gCHVs know that someone is interested in what they are doing, they are more likely to ask for help when they need it. 3. Be available to the gCHVs at all times Keep gCHVs Involved in Discussions 4. Frequently ask questions

of gCHVs to check their understanding and to keep them actively thinking and participating. Questions that begin with "what," "why," or "how" require more than just a few words to answer. Avoid questions that can be answered with a simple "yes" or "no." After asking a question, PAUSE. Give gCHVs time to think and volunteer a response A common mistake is to ask a question and then answer it yourself. If no one answers your question, rephrasing it can help to break the tension of silence. But do not do this repeatedly. Some silence is productive 5. Acknowledge all gCHVs responses with a comment, a "thank you" or a definite nod. This will make the gCHVs feel valued and encourage participation. If you think a gCHV has missed the point, ask for clarification, or ask if another gCHV has a suggestion. If a gCHV feels his comment is ridiculed or ignored, he may withdraw from the discussion entirely or not speak voluntarily again. 6.

Answer gCHVs questions willingly, and encourage gCHVs to ask questions when they have them rather than to hold the questions until a later time. 7. Do not feel compelled to answer every question yourself Depending on the situation, you may turn the question back to the gCHV or invite other gCHVs to respond. You may need to discuss the question with another facilitator before answering. Be prepared to say "I dont know but Ill try to find out" 8. Use names when you call on gCHVs to speak, and when you give them credit or thanks. Use the speakers name when you refer back to a previous comment. 9. Always maintain eye contact with the gCHVs so everyone feels included Be careful not to always look at the same gCHVs. Looking at a gCHV for a few seconds will often prompt a reply, even from a shy gCHV. General Community Health Volunteers Training Facilitators’ Guide 6 Keep the Session Focused and Lively 10. Keep your presentations lively:  Present information

conversationally rather than read it.  Speak clearly. Vary the pitch and speed of your voice  Use examples from your own experience, and ask gCHVs for examples from their experience. 11. Write key ideas on a news print as they are offered (This is a good way to acknowledge responses. The speaker will know his suggestion has been heard and will appreciate having it recorded for the entire group to see.) When recording ideas on a flipchart, use the gCHVs own words if possible. If you must be briefer, paraphrase the idea and check it with the gCHV before writing it. You want to be sure the gCHV feels you understood and recorded his idea accurately. Do not turn your back to the group for long periods as you write 12. At the beginning of a discussion, write the main question on the flipchart This will help gCHVs stay on the subject. When needed, walk to the flipchart and point to the question. Paraphrase and summarize frequently to keep gCHVs focused. Ask gCHVs for clarification of

statements as needed. Also, encourage other gCHVs to ask a speaker to repeat or clarify his statement. Restate the original question to the group to get them focused on the main issue again. If you feel someone will resist getting back on track, first pause to get the groups attention, tell them they have gone astray, and then restate the original question. Do not let several gCHVs talk at once. When this occurs, stop the talkers and assign an order for speaking. (For example, say "Lets hear Pomas comment first, then Margerates, then Sara s.") People usually will not interrupt if they know they will have a turn to talk. Thank gCHVs whose comments are brief and to the point. 13. Try to encourage quieter gCHVs to talk Ask to hear from a gCHV in the group who has not spoken before, or walk toward someone to focus attention on him and make him feel he is being asked to talk. Manage any Problems 14. Some gCHVs may talk too much Here are some suggestions on how to handle an overly

talkative gCHV:  Do not call on this person first after asking a question.  After a gCHV has gone on for some time say, "You have had an opportunity to express your views. Lets hear what some of the other gCHVs have to say on this point." Then rephrase the question and invite other gCHVs to respond, or call on someone else immediately by saying, "Sarah, you had your hand up a few minutes ago." 7 General Community Health Volunteers Training Facilitators Guide    When the gCHV pauses, break in quickly and ask to hear from another member of the group or ask a question of the group, such as, "What do the rest of you think about this point?" Record the gCHVs main idea on the flipchart. As he continues to talk about the idea, point to it on the flipchart and say, "Thank you, we have already covered your suggestion." Then ask the group for another idea Do not ask the talkative gCHV any more questions. If he answers all the

questions directed to the group, ask for an answer from another individual specifically or from a specific subgroup. (For example, ask, "Does anyone on this side of the table have an idea?") 15. Try to identify gCHVs who have difficulty understanding or speaking the course language. Speak slowly and distinctly so you can be more easily understood and encourage the gCHV in her efforts to communicate. 16. Discuss disruptive gCHVs with your co-facilitators You may be able to discuss matters privately with the disruptive individual.) Reinforce GCHVs Efforts 17. As a facilitator, you will have your own style of interacting with gCHVs However, a few techniques for reinforcing gCHVs efforts include:  avoiding use of facial expressions or comments that could cause gCHVs to feel embarrassed,  sitting or bending down to be on the same level as the gCHV when talking to him,  answering questions thoughtfully, rather than hurriedly,  encouraging gCHVs to speak to you by

allowing them time,  appearing interested, saying "Thats a good question / suggestion." 18. Reinforce gCHVs who:  try hard  ask for an explanation of a confusing point  do a good job on an exercise  participate in group discussions  help other gCHVs (without distracting them by talking at length about irrelevant matters). B. Techniques for Relating Modules to gCHVs Jobs 19. Discuss the use of these case management procedures in gCHVs own day to day practice. The guidelines for giving feedback on certain exercises suggest specific questions to ask. Be sure to ask these questions and listen to the gCHVs answers. This will help gCHVs to begin to think about how to apply what they are learning. 20. Reinforce gCHVs who discuss or ask questions about using these case management procedures by acknowledging and responding to their concerns. General Community Health Volunteers Training Facilitators’ Guide 8 C. Techniques for Assisting Co-facilitators 21.

Spend some time with the co-facilitator when assignments are first made Exchange information about prior teaching experiences and individual’ strengths, weaknesses and preferences. Agree on roles and responsibilities and how you can work together as a team. 22. Assist one another in providing individual feedback and conducting group discussions. For example, one facilitator may lead a group discussion, and the other may record the important ideas on the flipchart. The second facilitator could also check the Facilitator Guide and add any points that have been omitted. 23. Each day, review the teaching activities that will occur the next day (such as role plays, demonstrations, and drills), and agree who will prepare the demonstration, lead the drill, play each role, collect the supplies, etc. 24. Work together on each module rather than taking turns having sole responsibility for a module. When gCHVs are performing assigned task:       Look available, interested

and ready to help. Watch the gCHVs as they work, and offer individual help if you see a gCHV looking troubled, staring into space, not writing answers, or not turning pages. These are clues that the gCHV may need help. Encourage gCHVs to ask questions whenever they would like some help. If important issues or questions arise when you are talking with an individual, make note of them to discuss later with the entire group. If a question arises, which you feel you cannot answer adequately, obtain assistance as soon as possible from another facilitator or the Course Director. Review the points in this Facilitator Guide so you will be prepared to discuss the next exercise with the gCHVs. When Providing Individual Feedback:     9 Before giving individual feedback, refer to the appropriate notes in this guide to remind yourself of the major points to make. If the gCHVs answer to any exercise is incorrect or is unreasonable, ask the gCHV questions to determine why the error

was made. There may be many reasons for an incorrect answer. For example, a gCHV may not understand the question, may not understand certain terms used in the exercise, may use different procedures, may have overlooked some information about a case, or may not understand a basic process being taught. Once you have identified the reason(s) for the incorrect answer to the exercise, help the gCHV correct the problem. For example, you may only need to clarify the instructions. On the other hand, if the gCHV has difficulty understanding the process itself, you might try using a specific case example to show step-by-step how the case management charts are used for that case. After the gCHV understands the process that was difficult, ask him to work the exercise or part of the exercise again. Summarize, or ask the gCHV to summarize, what was done in the exercise and why. Emphasize that it is most important to learn and remember the General Community Health Volunteers Training Facilitators

Guide  - process demonstrated by the exercise. Give the gCHV a copy of the answer sheet, if one is provided. Always reinforce the gCHV for good work by (for example): commenting on his understanding, showing enthusiasm for ideas for application of the skill in his work, telling the gCHV that you enjoy discussing exercises with him, letting the gCHV know that his hard work is appreciated. When Leading a Group Discussion:        - Plan to conduct the group discussion at a time when you are sure that all gCHVs will have completed the preceding work. Wait to announce this time until most gCHVs are ready, so that others will not hurry. Before beginning the discussion, refer to the appropriate notes in this guide to remind yourself of the purpose of the discussion and the major points to make. Always begin the group discussion by telling the gCHVs the purpose of the discussion. Often there is no single correct answer that needs to be agreed on in a discussion.

Just be sure the conclusions of the group are reasonable and that all gCHVs understand how the conclusions were reached. Try to get most of the group members involved in the discussion. Record key ideas on a flipchart as they are offered. Keep your participation to a minimum, but ask questions to keep the discussion active and on track. Always summarize, or ask a gCHV to summarize, what was discussed in the exercise. Reinforce the gCHVs for their good work by (for example): praising them for the list they compiled, commenting on their understanding of the exercise, commenting on their creative or useful suggestions for using the skills on the job, praising them for their ability to work together as a group. When Coordinating a Role Play:    Before the role play, refer to the appropriate notes in this guide to remind yourself of the purpose of the role play, roles to be assigned, background information, and major points to make in the group discussion afterwards. As gCHVs

come to you for instructions before the role play, assign roles. At first, select individuals who are outgoing rather than shy, perhaps by asking for volunteers. If necessary, a facilitator may be a model for the group by acting in an early role play. give role play gCHVs any props needed. give role play gCHVs any background information needed. (There is usually some information for the "mother" which can be photocopied or clipped from this guide.) suggest that role play gCHVs speak loudly. allow preparation time for role play gCHVs. When everyone is ready, arrange seating/placement of individuals involved. Have the "mother" and "health worker" stand or sit apart from the rest of the group, where everyone can see them. General Community Health Volunteers Training Facilitators’ Guide 10       Apply the counselling skill during role play “APAC” (Ask, Praise, Advise and Check). Begin by introducing the players in their roles and

stating the purpose or situation. For example, you may need to describe the age of the child, assessment results, and any treatment already given. Interrupt if the players are having tremendous difficulty or have strayed from the purpose of the role play. When the role play is finished, thank the players. Ensure that feedback offered by the rest of the group is supportive. First discuss things done well Then discuss things that could be improved. Try to get all group members involved in discussion after the role play. In many cases, there are questions given in the module to help structure the discussion. Ask gCHVs to summarize what they learned from the role play. When conducting Drill exercises: • Gather the participants together and tell them you will conduct a drill. During the drill, they will review the steps • • Explain the procedures for doing the drill. Tell participants: This is not a test. The drill is an opportunity for participants to practice recalling

information a gCHV needs to use when assessing and classifying sick children. • Call on individual participants one at a time to answer the questions. You will usually call on them in order, going around the table. If a participant cannot answer, go to the next person and ask the question again. • Participants should wait to be called on and should be prepared to answer as quickly as they can. This will help keep the drill lively • Start the drill by asking the first question. Call on a particular participant to provide the answer. He should answer as quickly as he can Then ask the next question and call on another participant to answer. If a participant gives an incorrect answer, ask the next participant if he can answer. • Continue the drill until all the participants can answer correctly. Checklist of items needed to work with Manual Materials necessary for all         Name tag Note book Ball pen Eraser Clip board Highlighter Pencil Pencil

sharpener 11 General Community Health Volunteers Training Facilitators Guide Items needed for all groups:         Stapler with pin Extra pencil and eraser Flip chart paper Glue stick Big cello tape Scissor Highlighter Punching machine When Facilitating A Community / Clinical Session: Clinical Session Start the session with a demonstration of the case Start the session with a demonstration of the case. Choose a case which is simple and without any complications. Complicated cases will unnecessarily lengthen the demonstration and divert the attention of the gCHVs to less important things. Explain the objective of the session Explain the objective of the session and make clear as what the gCHVs are expected to learn in this session. Demonstrate various steps of assessment, classification and treatment of sick child. Demonstrate the skills of counselling to the mother and emphasis on Check questions Summarize the demonstration. Provide all the gCHVs with

related cases and explain what is expected from them. Closely observe assessment, classification and treatment done by each gCHV and provide necessary feedback on the spot. Emphasize the importance of the gCHV following the sequences of activities. Summarise the Community practical session At the end of the session summarize all the activities performed during the session and point out the strengths and weaknesses seen during the session. Roles and Responsibilities of gCHV 1. 2. 3. 4. Must be able to facilitate or guide the community in child health related activities Must be able to deliver health messages effectively Have good interpersonal skills Must be able to liaise with health facilities within the catchment area for service delivery 5. To distribute various commodities (eg FP, mosquito nets, condoms,) 6. To identify high risk conditions and danger signs and refer 7. To organize community meetings in collaboration with other community leaders 8. To perform surveillance

activities and make report to the local health authority 9. To report births and deaths to health facility and community leaders 10. To follow-up health on relevant cases and make referrals 11. Exhibit/practice/personify healthy life-style General Community Health Volunteers Training Facilitators’ Guide 12 Scope of work 1. 2. 3. 4. 5. Create awareness of Child health problems Coordination of health activities Reporting on health related activities in prescribe format by the MOH & SW Referral of relevant cases Distribution of health commodities and materials 6. Get support from TTM, CM, CHDC, and other community health/development groups 7. Demonstration of healthy behavior and practices Selected contents of gCHV Training Manual As per the decisions made on the contents of the training manual for general community health Volunteers, this facilitators guide has come-up. For each of these areas, modules and job aids are developed or adapted from the relevant existing generic

(WHO) documents to facilitate the training of gCHV and implementation of gCHV activities. In the first phase of training, as a promotional activity diarrheal disease component is going to be introduced at the County level by MOH & SW of Liberia 13 General Community Health Volunteers Training Facilitators Guide Diarrhea- Facilitator Guide Training Schedule Morning session 1st Day 8:00-9:00 Registration, devotion and Breakfast 9:00-11:00 Setting up the climate Welcome and Introduction 2nd Day 3rd Day Registration, devotion and Breakfast Review of day 1 Registration, devotion and Breakfast Ground rules, participants hope and worries, setting up the workshop committees, pretest 11.00 – 1:00 Role and Responsibility of gCHVs Session : 1 How to prevent diarrhea Practice sessionasses and classify and record Background information? Concept of germ theory What is diarrhea? What are the causes of diarrhea? What are the signs of diarrhea? What are the complications of

diarrhea? What is dehydration? What are the general danger signs of dehydrations? What conditions for referrals Afternoon Session 2.00 – 500 Session:2 Assess and classify child for diarrhea and dehydration? Review of day 1 - - Assessment practices using classification card Practice session- asses and classify and record Practice session-treat and counsel and record HMIS data reporting Break Lunch Session:4 Practice session-treat and counsel and record Practice session – identify danger General Community Health Volunteers Training Facilitators’ Guide 14 signs and referral formázott: Behúzás: Első sor: 1 k Demonstrate the use of classification cards Demonstrate the management of diarrhea and dehydration and the four home rules What is the importance of rehydration? How can diarrhea be prevented Individual/group practices continues - Closing. - 3rd day follow- up 15 General Community Health Volunteers Training Facilitators Guide Steps Registration,

Distribution of Materials, and Logistics (30 minutes) 1. Ensure that all participants sign their names on the sign-in sheet as they enter the training room. Assist any non-literate participants by writing their names for them Give each person their pen, pencil, etc. as they sign in 2. Review logistics related to the workshop, such as start and end times, how breaks and lunch will be handled, where the toilets are, whom to ask if they have administrative questions, funds to be provided for anything, etc. 3. Very briefly review the workshop timetable 4. Ask the health of the health facility or the town chief to welcome the participants to the workshop and make them feel at home Introduction of participants and facilitators (30 minutes) 1. Tell participants they will choose a partner introduce themselves to their partner In their introduction, they should say their name, where they live, likes, dislikes hope and worries, one thing that is special about the village in which they live, and

one reason they were chosen to be the gCHVs for their community. 2. Tell them they should each spend no more than 1-2 minutes talking Facilitators should start by introducing themselves, thereby setting an example. Norms and Expectations (30 minutes) 1. Ask participants to come up with simple rules and regulations to help the workshop go smoothly. Keep it short Add anything important that is missing, such as being on time, turning cell phones down, and showing everyone respect throughout. 2. Now ask participants ‘why are we here?” to say what they expect from this workshop – it can be what they expect to learn or gain, what they expect to happen during or after the workshop, or what they expect to contribute to the workshop. 3. List the main points on flip chart paper to refer to during the workshop as appropriate and at the end to see which expectations were met. If any of the expectations are completely unrealistic, mention that they will not be met during this particular

workshop. 4. Facilitators may add their expectations as well 5. Summarize by asking participants how they can share in the responsibility of ensuring that norms are followed and expectations are met. Trainers Notes Facilitators’ Expectations – Include things such as:  Participants will engage actively in the learning process, including sharing relevant knowledge and experience.  Participants will feel free to ask questions when they do not understand or want clarification. General Community Health Volunteers Training Facilitators’ Guide 16 Setting up workshop committee Tell participants that they will set up committee for the course of the workshop. Encourage all participant to the color they like you may use any four colors. List their names the flip chart under the color they have chosen for example: Red Green Blue White 1. 1. 1. 1. 2. 2. 2. 2. 3. 3. 3. 3. 4. 4. 4. 4. 5. 5. 5. 5. Activity Day 1 Day 2 Day 3 Day 4 Day 5 News & Blue

Red Green Black Blue - Green Black Blue Red Green Black Blue Red Green Black Blue Red Green Black Posting Recap Welfare Clean up Devotion & Ice Ice breaker Breaker only Activity Responsibilities News & • Highlight Local news Posting • assist with posting and Numbering all newsprint sheets during workshop Recap • Recap / summarize previous days activities and key messages Welfare/ • Ensure water & soap is available for hand washing & tissue for Clean up latrine. 17 General Community Health Volunteers Training Facilitators Guide • Communicate with Cooks re: breakfast & lunch schedule • Clean up venue after/before workshop Devotion & • Prepare & lead Devotions Ice breakers • assist with ice breakers Trainer notes: Key Points: You are a special group of community members that have been chosen to by your community to identify and treat malaria in under 5 children. Create a chart on Newsprint as

follows: Inform Red group that they will recap on Friday and Black group will give devotion on Friday *At the end of each day remind the groups of their duties for the following day.* . Step 2: Pre-test Objectives By the end of this session, participants and facilitators will have a baseline against which to measure participants’ progress. Methods • Individual work or break into groups those that would like to take a written test and those that would like to take an oral test. Training Aids and Materials • Pre/Post-test Answer Sheets Handouts • Pre/Post-test Questionnaire for Literate gCHVs s • Pre/Post-Test Questionnaire for Non-literate and Semi-Literate gCHVs Trainer Note: • Oral Test: Check only the responses given by the participant. Note in “other” if the response is not available. • See Sample Test for correct answers and value of each question General Community Health Volunteers Training Facilitators’ Guide 18 Session 2: Roles and

Responsibilities of gCHVs Objectives By the end of this session, participants will be able to:  Describe their role as gCHVs.  Mention at least two things the Community health supervisor and Peer Supervisors do to help gCHVs and the program.  Describe the role of the clinic’s in-charge vis-á-vis the gCHVs, gCHV  Peer supervisor, Methods Brainstorming and discussion Preparation If no PHU staff is available to co-facilitate the workshop, consider inviting someone from the DHMT to speak briefly during this session. Training Aids and Materials • • Flipchart with clinic roles and responsibilities in CCM • Flipchart with Peer Supervisor, CCM Officer, and DHMT Roles • Flipchart with organization chart showing relationships among CBD, supervisor, officer, and clinic Handouts • CBD Job Description • Key Roles in Management • CBD Ethics • CBD Agreement Community 19 General Community Health Volunteers Training Facilitators Guide Case

Steps gCHVs Roles (15 minutes) Introduce the session 1. Remind participants that their communities have selected them to perform a very important role. They will have a lot of responsibility in their community. It is important that the gCHV do his/her job well and keep accurate records. This way, the health of children should improve, and we should know about it. 2. Break into groups with one secretary: What are the duties of the gCHV? 4-5 minutes 3. Ask secretary or any member of the group to present or tell the larger group what the group discussed. 4. Distribute the gCHVs Job Description Have participants take turns reading the listed tasks aloud (one task per person). Get input on and briefly discuss each task. Tell them they will learn more about their gCHV work as the training progresses. 5. Ask if they have any questions or concerns about the responsibilities listed 6. Draw participants’ attention to the “Characteristics of a Good gCHV” section of the job description.

After having participants read it aloud, ask if and how these characteristics relate to the reasons they said their communities selected them. 1. Ask trainees what are the current roles of the clinic in the community Possible answers include: • Treat patients • Provide outreach services • Mobilize the community for improved health • Manage referred patients and give feedback on them • Work together in managing epidemics or emergencies • Distribute commodities such as ITNs/LLINs 2. Display flipchart with clinic roles and responsibilities in CCM Explain to trainees that health workers from now on will also: • Support communities during selection of gCHVs Participate in the training and supervision ofsupervises General Community Health Volunteers Training Facilitators’ Guide 20 • Replenish drug stocks for CBDs • Manage sick children referred by the CBDs • Integrate records of Peer Supervisors into HMIS • Investigate and follow up problems

reported by the community that may be related to the CBD’s work 3. Display flipchart with Peer Supervisor, CHSS, and HFs key roles Discuss roles, asking if there are other things any of them should be doing. 4. End by saying that gCHVss do not need to remember all of this information but that they should feel free to ask for non-monetary support in doing their work better from any of the people discussed. Trainer’s Notes Peer Supervisor        Reports to CHSS Links gCHVs with CHVs Visits other CHVs to observe their work Helps CHvs improve their skills Helps CHVs solve problems Adds up CHVs’ monthly drug supply Combines information from the CHVs’ reports CHSS  Trains gCHVs and Peer Supervisors  Links health facilities, with the communites  Provides information to the health facilities and Peer Supervisors  Directly oversees the Peer Supervisors, along with the Health faciltie DHOs  Partners with on community case management  Oversees

the health facilities  Compiles reports from health facilitiess  Feeds back information about the overall health of the community Stop Selection criteria for gCHV • Should be respected, permanent, member of the community • Should be able to sustain himself 21 General Community Health Volunteers Training Facilitators Guide • Should be willing to volunteer • permanent resident • respected / good moral character • female/male (female preferred in Muslim pop.) Examples: • Be available to caretakers of under 5 children who are sick. • Recognize signs of diarrhea and other illnesses (malaria, ARI) • Treat or refer as per module guidelines, • counsel caretaker on home management and prevention of common illnesses, • counsel caretaker on how to take medicine given. • Motivate community members to take responsibility for their own health through preventative activities such as proper hand washing, proper use of ITN, carrying sick children

to the clinic when danger signs appear. • Have back pack with supplies available at all times. Activity 3: Have each group representatives present and Discuss. Activity 4: Do you think it is important that the Ministry of Health offers curative health services through the gCHV directly in the community rather than ONLY in the clinic? What are the advantages and disadvantages of the Community Case Management program? Only allow one person- one comment, to encourage full participation of all participants. Advantages Disadvantages CHV is a general term for all health volunteers including TTMs, Hygiene promoters and gCHVs etc. What are the different volunteers that you have serving in your community? How does the community support them? gCHV offers health services right in your community. The Ministry of Health had concerns that by allowing health services in the community through Community Volunteers- the gCHV might become a General Community Health Volunteers Training

Facilitators’ Guide 22 “black bagger”. The OIC / N/A vaccinator/ CHSS must monitor the gCHV closely to ensure they work only within their capabilities and not become “black baggers”. “That’s plenty work for the gCHV!” Choose a partner: Ask the partner to describe what their typical day looks like from the time they wake up until they go to sleep at night. How long does each activity take? Questioning and Discussion: What is a Volunteer? Does a volunteer get paid? Why do you want to be a gCHV? How will you fit the duties of the gCHV into your daily activities? What will motivate you to remain committed to your work? (that does not include cash!) Conclusion: The Ministry of Health has been very cautious in allowing non professional persons to treat malaria, diarrhea and pneumonia in their community. You will have to demonstrate to us, that you are committed and able to carry out your duties accurately to protect children from wrong treatment and overdose which can

kill. In this workshop you will have to prove your competence in recognizing the signs of fever, diagnosing malaria through the RDT test kits and giving the correct tablets to children under 5 before we can recommend the National Malaria Control program to give you ACT malaria drugs. You will be taught how to use the manual to identify danger signs and how to counsel the mother in the care and prevention of a malaria child. We trust you will all pay keen attention to all activities and participate to the fullest. In order to ensure that you will not be distracted, we would like you to come up with Ground rules that will help make this training a success. Those that are willing to learn these new skills and serve the sick children in their community: Please stand! Give a big clap for their dedication and volunteer service!! Activity 5: Group: Brainstorm for ground rules (such as: cell phones off or on silent, be recognized before you speak, respect others view, no session in session,

Respect time, etc.) and consequence for breaking rules Any other Administrative matters: question and answer period 23 General Community Health Volunteers Training Facilitators Guide Activity 6: Drama/Role Play: Characters: gCHV, Mother and child under 5 Mother comes with child to gCHV because the child skin hot. The gCHV talks plenty to the mother. “You the cause, you giving the child water but the baby too small, the community is dirty etc. Gives the child medicine ACT blister pack and tells the ma to give this to the child 3 times. SHOWD: • gCHV does not treat the mother with respect. • gCHV talks down to the mother • gCHV does not observe the child’s condition • gCHV does not take patient history • gCHV does not explain things well • gCHV does not find out what the mother knows about malaria • gCHV does not demonstrate home treatment for malaria (bathe in cool water) • gCHV does not give paracetamol • gCHV does not test the child with RDT

before giving ACT • gCHV does not demonstrate how to give the first dose to the child • gCHV does not instruct re: danger signs and follow up General Community Health Volunteers Training Facilitators’ Guide 24 • 25 General Community Health Volunteers Training Facilitators Guide Case Management Responsibilities of gCHVs:• Correctly assess of Children <5 years of age for diarrhea. • Manage and treat dehydration of all children under 5 years by applying the 4 home rules of management of dehydration. • Correct preparation of ORS at home • Correct demonstration on how to feed zinc tab to a child with diarrhea. • Prevention of diarrhea. • Refer all under 5 children with danger signs to the health facilities. • Follow-up of treated and referral cases on third day. • Counsel to mother about danger signs of dehydration to look for. • Advice mother on how to prevent diarrhea. • Recording and Reporting. Session: 1 Topic: Diarrhea Time: 2hrs

Objectives: By the end of this session participants will be able to: • • • • • • • • • • • Define meaning of diarrhea Identify the causes of diarrhea Identify at least three signs of diarrhea gCHVs can manage Identify at least three danger signs of diarrhea and dehydration Identify result of dehydration Describe what is dehydration? Assess, classify and manage diarrhea and dehydration Counsel a mother List at least five reasons for referrals Demonstrate recording and filling in treatment and HMIS register List five ways to prevent diarrhea and dehydration Training materials Training manual Facilitators guide General Community Health Volunteers Training Facilitators’ Guide 26 Marker Flipchart Classification cards ORS Sackets 1 liter cup, teaspoon, cook spoon, a liter bottle Soap or ashes and water to wash hands Safe drinking water Training Methodology • • • • • Introduce the topic and make participants to feel comfortable- be friendly Read

objectives Distribute participants hand out or do a role play on how people get germ Ask participants to turn to page 2 of participant manual- concept of germ or use a discussion starter on germ theory Ask the following questions -What did you see happening? What are the causes of this? Why do people do this? What are the results of this? Does it happen in real l life? Ask participant: Do you know any under 5 children in your area who have died from Diarrhea? Allow participant to narrate their stories o Discuss why diarrhea is a big problem in Liberia. How can we prevent ourselves from getting sickness? Brain storm Ask 2 or 3 participant to give the mean of diarrhea Turn to page 4Read the meaning of diarrhea- and be sure participate understand the case definition Ask participants to repeat the meaning several times after you Ask each participant to repeat the meaning of diarrhea If participants can read, the ask one participant to read the meaning of diarrhea on page 4 • Ask one

participant to read the page and identify the meaning of the picture? • • Ask participant or role play the cause of diarrhea• Read or ask one participant to read from page5 • .Ask to repeat the causes of diarrhea, the ask each participant to name one cause of diarrhea • Role play or brain storm the signs of diarrhea • Turn to page 6 of the participants hand out • Read or ask each participant to read the signs of diarrhea • Ask participants to repeat • Ask each participant to repeat the signs of diarrhea 27 General Community Health Volunteers Training Facilitators Guide • Facilitator summary the course Diarrhea What is diarrhea? How do we get diarrhea? What are the signs and symptoms of diarrhea in young children? How can we prevent diarrhea? Frequent passing of watery stools three or more times per day/24 hours. Diarrhea is caused by germs and other organisms found in contaminated food or water Frequent watery stools, sunken eyes and fontanel. Weakness,

abnormal sleepiness or lethargy. Increased thirst, irritability, restlessness. Pinched skin returns to normal slowly or very slowly. Scanty or no urine. Dry lips or loss of weight Eat well-prepared food. [Specify what this means] Wash hands before feeding your child. Wash hands after toilet. Wash hands before preparing any food Do not leave food uncovered. Evaluation: Why diarrhea is a big problem in Liberia? What is diarrhea? What are the causes of diarrhea in? Liberia? What are the signs of diarrhea? What is the complication of diarrhea? Session: 2 Topic: what is dehydration? Time: 3 hrs Session objectives: At the end of the second session participants will be able to:• Define dehydration • Recognized the signs and symptoms of dehydration • List the complication of dehydration • Assess , Classify and manage and record some dehydration • Counsel the mother • Identify the referral condition of dehydration. • Fill the referral form • Training materials: Training

manual General Community Health Volunteers Training Facilitators’ Guide 28 Facilitators guide Marker Flipchart Training Methodology: • • • • • • • • • • • • Link with previous session and introduce the topic. Ask participants what they have observed and experienced during diarrhea occurrence with their children. Ask participants to pair up and discuss the signs of dehydration Ask each team to report to the larger group Ask participants to turn to page------Ask for the meaning of dehydration and how to recognize dehydration in the community. Brainstorming: what are the signs of some dehydration? Ask participant to name the danger signs of dehydration Asks participants to name condition for referrals Ask in between the session, to know the understanding of the participants. Ask participants to turn page number ---------of manual about referral condition of diarrhea and allow one participant to read the points of referral condition. Assign participants

into sub-groups for discussion on refer condition of diarrhea and ask for sub-group presentation, why and when need to be referred immediately to the clinic or Health Centers. Introduce the classification card and tell participants that this will help to identify the danger signs of diarrhea and be able to refer quickly Summarize by the facilitators. Evaluation: What are the signs and symptoms of dehydration? What are the referral conditions of diarrhea? Conduct a drill exercise on key information on diarrhea. Questions Answers (yes or no) 1. Weakness is not a sign of diarrhea Yes, it is. 2. Going in the toilet more than three times is not diarrhea Yes 3. Passing one heavy watery stool in a day is diarrhea. No 29 General Community Health Volunteers Training Facilitators Guide 4. drinking plenty water can prevent dehydration. Yes 5. drinking plenty water can replace the water in the body Yes 6. You become dry when water is finished from your body Yes 7. A child should

drink more water when she/he has diarrhea Yes 8. Stop feeding children when they have diarrhea No 9. Give ORS to a child with diarrhea Yes 10. Send a child with bloody diarrhea to the Yes clinic The Session: 2 Topic: Assess, classify and manage Time: 3 hrs Session objectives: At the end of the second session participants will be able to: • Assess a child with diarrhea and dehydration • Manage a child with some dehydration • Counsel a mother with whose child has is classified as some dehydration • Mange a child with danger signs or severe diarrhea • Record in the treatment register what has being done Training materials • Classification cards • ORS Sackets • 1 liter cup, teaspoon, cook spoon, a liter bottle • Soap or ashes and water to wash hands • Safe drinking water • A doll Training Methodology: • • • • Link with previous session and introduce the topic. Ask each team to report to the larger group Ask participants to turn to page------Ask for

the meaning of dehydration and how to recognize dehydration in the community. General Community Health Volunteers Training Facilitators’ Guide 30 • • • • • • • Brainstorming: what are the signs of some dehydration? Ask participant to name the danger signs of dehydration Asks participants to name condition for referrals Ask in between the session, to know the understanding of the participants. Ask participants to turn page number ---------of manual about referral condition of diarrhea and allow one participant to read the points of referral condition. Assign participants into sub-groups for discussion on refer condition of diarrhea and ask for sub-group presentation, why and when need to be referred immediately to the clinic or Health Centers. Introduce the classification card and tell participants that this will help to identify the danger signs of diarrhea and be able to refer quickly Summarize by the facilitators. Case studies: A. Ma Hawa’s one year old

child has passed five watery stools since this morning. Question 1. What is Ma Hawa’s child suffering from? 2. How could gCHV classify Hawa 3. What action should be taken? B. Ma Hawa’s one year child has a dry lip and wants to drink water quickly and frequently. 1. What is Ma Hawa’s child suffering from? 2. How could you classify ma Hawa child? 2. What action should be taken? C. Ma Bendu’s 2 years old child has passed 2 stools with blood 1. What is Ma Bendu’s child suffering from? 3. How could you classify Ma Bendu child? 2. What action should be taken? Session: 3 Topic: Four rules for home treatment of diarrhea 31 General Community Health Volunteers Training Facilitators Guide Time: 4 hrs Session objectives: At the end of the session participants will be able to:- List the four rules for home treatment in diarrhea. - Describe the importance and type of extra fluid needed to prevent dehydration - Describe the importance and type of extra food needed to prevent

malnutrition. - Correctly prepare ORS. Training materials: Training manual Facilitators guide Marker Flipchart ORS packets, Bucket or Jar, Drinking water, Soap and towel Training Methodology: • • • • • • • • • Link with previous session and introduce the topic. Ask participants to turn relevant page. Ask one participant to read the participants manual. Form sub-groups and assign, what types of fluid and food can be recommended during diarrhea. Observe participants activities and let them summarize the group work for presentation in plenary. Add and clarify the confusion of the participants and summarize at the end. Demonstrate the correct preparation procedure of ORS, also focusing on hand washing practices. Assign participants into sub-groups for practical exercises. Summary by the facilitators. Evaluation: Ask for return demonstration to prepare ORS. Ask for any extra detail to be clear Session: 4 Topic: Cont. topic of four rules for home treatment of

diarrhea Time: 3 hrs Session objectives: At the end of the session participants will be able to answer:What are Zinc and its importance in prevention of diarrhea? Age specific correct dose of zinc for under 5 children. General Community Health Volunteers Training Facilitators’ Guide 32 List the referral conditions of diarrhea. Training materials: Training manual Facilitators guide Flipchart Marker Zinc, spoon, drinking water, Towel Training Methodology: • • • • • • • • • • Link with previous session and continue the session. Ask participants to turn relevant page number Ask one participant to read the participants manual. Explain what zinc tablet is and its importance; Write the main points on the chart and fix in the wall. (Zinc is an essential micronutrient for the body It is available in dispersible form. It can be prepared with clean drinking water or breast milk in a table spoon. it helps to reduce:25% of diarrhea duration, 29% severity and 40% of

mortality of diarrhea diseases 15 -20 % zinc is lost with each episode of diarrhea. Therefore zinc needs to be administered with each episode of diarrhea according their age group.-WHO) Describe and demonstrate the age specific dose of zinc. Ask the participants to go in group for practice of dosing and its test. Provide support in between session. Ask participants on when to take child immediately to the clinic and Health center. List the points and reinforce Conduct drill exercises on when to return back immediately or need to refer to the clinic. Summary by the facilitators. Evaluation: Conduct drill exercise for age specific zinc dose Ask for any extra detail to be clear. Session: 5 Topic: How to prevent diarrhea Time: 4 hrs Session objectives: At the end of the session participants will be able to:- List and describe the main points of preventive methods of diarrhea. 33 General Community Health Volunteers Training Facilitators Guide - Correct assessment of diarrhea

using classification card. Counsel the mother on diarrhea case management. Training materials: Training manual Facilitators guide Flip chart Marker Classification card Training Methodology: • • • • • • • • • • Link with previous session. Ask participants to turn relevant page number Ask participants about the main points of preventative methods of diarrhea. Write the points in the news print. Ask one or two participants to read the manual on how to prevent or stop diarrhea from spreading to a healthy child. Discuss the points of preventive methods of diarrhea. Describe and demonstrate the counseling method “APAC” (Ask, Praise, Advise and Check). Divide the participants into 4 group and assign 4 topic for counseling using the APAC formula Provide the feedback Summary by the facilitators. Evaluation: Question and Answer Session: 6 Recording and Reporting Closing and TADA Malaria- Facilitator Guide Training Schedule Session Morning Session 9.00 – 100

1st Day • • • Registration of the participants Welcome and Introduction Ground rules setting 2nd Day Session: 3 - Review of day first - Management of Malaria in 3rd Day Session:5 General Community Health Volunteers Training Facilitators’ Guide - Review of day 2nd. - Prevention of Malaria 34 • Role and Responsibility of gCHVs the community - Practices by using classification card Session : 1 - Background information - Definition of Malaria - Signs and symptoms of uncomplicated malaria Afternoon Session 2.00 – 500 • • • • Session:2 Break Review of previous session Danger signs of Malaria Differentiate simple and complicated malaria Referral condition Session:4 - Cont. Management of Malaria in community - Practice of dose calculation - 3 rd day follow-up Session:6 - Recording and Reporting - Closing. Role and Responsibilities of gCHVs:• Assess of Children 5 years of age for Malaria. • Management of uncomplicated malaria for children 2 months

to 5 years (> 5Kg to). • Refer of all complicated and < 5 kg wt child. • Follow-up of treated and referral cases. • Counsel to mother about danger signs to look for home care. • Advice to community and mother to take preventive measure of Malaria prevention. • Recording and Reporting. Malaria: Session: 1 Time: 3 hours Topic to be covered: Definition of malaria Signs and symptoms of simple (uncomplicated) malaria How does one gets malaria Objectives: At the end of the session participants/gCHV should be able to: - Define malaria - Explain how one gets malaria (mode of transmission) - Describe signs and symptoms of Malaria 35 General Community Health Volunteers Training Facilitators Guide Training Materials 1. Training manual 2. Flip chart 3. Permanent Markers 4. Visual aids malaria flip chart 5. Pens and note pads Training methodology • Discussion and presentation –facilitator will introduce the topic, states the Role and responsibility of gCHV, objectives,

defines malaria, emphasizing the problem of malaria in Liberia. • Ask 2-3 participants and lead discussion, how one gets malaria and signs and symptoms of malaria. • Signs are what the clinician feels and observes on the sick person like fever or weakness. Symptoms are what the sick person feels as a result of the illness like fever which is both a sign and symptom. • Ask participants to turn to relevant page---(photo on how to check for fever and that mosquito) Then each paragraph is read by a participant and explained by the facilitator. Question period: facilitator will allow participants to ask questions and all answers will be discussed. Evaluation: Each participant should be allowed to define malaria, describe how one gets malaria and signs and symptoms of malaria. Malaria: Session: 2 Danger signs of Malaria Time: 3 hours Topic to be covered: danger signs of malaria Objectives At the end of the session, the participants will be able to: 1) Describe the danger signs of

malaria 2) Differentiate simple malaria from complicated malaria 2) Take immediate action-Referral Training materials required:     Training manual malaria flip chart Stationery Classification card with danger signs Training methodology: General Community Health Volunteers Training Facilitators’ Guide 36 Lecture by facilitator-introduction of the topic Discussion: each danger sign, very weak, convulsion, unable to feed or drink and not breathing well (fast or slow) and what action to be taken in case of danger signs. Role play to assess for malaria, advise to mother and referral NB: there may be other causes of danger signs such a severe pneumonia and dehydration. Make sure the danger signs observed are not due to other diseases Evaluation Case study1: to be inserted) Case study2: Case study 3 Case study 4: Session: 3 Topic: management of Malaria Time: 3 hours - Objectives: At the end of the session, participants will be able to: Correctly treat children 4-6 m

and 1-4 years with simple malaria Take correct procedure if the child does not improve. Training materials: Training manual Visual aids Classification card Cups, tea spoons and drinking water for demonstration Stationery Children treatment card for malaria Training methodology: • • • • • • • Introduction of topic by facilitator Take correctly the verbal consent from the family before initiation of treatment. Demonstrate correct age or weight specific dose of ACT by the facilitator. Apply the procedure of case management of fever/malaria by gCHV - Greet the mother politely. - Ask about the child condition. - Ask how old the child is. -Ask how long the fever/complaint is - Assess the child by using the classification card Discuss on the dosages according to ages Danger of over and under dosing Ask any extra detail need to know by the participants. 37 General Community Health Volunteers Training Facilitators Guide • • Divide the participants with drugs into sub

group. Provide exercise paper as given below. EXERCISE: In this exercise you will practice using the box "Give an Appropriate ACT drugs. Select the correct dose and write the dose and schedule for each of the cases below. Assume that this is the first time each child is being treated for the malaria illness. 1. A 6-month-old (7 kg) child. 2. A child (10 kg) Child. 3. A 2-year-old (11 kg) child. 4. A child (16 kg). 5. A child (5 kg). 6. A 36-month-old child (15 kg). Continuation of first Session Session: 4 Time: 4 hrs. Assessment by using classification card; (Feel for fever, Check for weakness, Ask about feeding; ask about vomiting and how often) Check for danger signs. - If any danger sign is present, refer the patient immediately to the health facility. - If no danger sign is present, check for other causes of fever, such as pneumonia, ear infections or measles. If no other cause for the fever can be observed, treat for malaria. - Treatment for malaria: Bathe

the child with cold water (Not icy water) to prevent jerking and damage to the brain. Give paracetamol tablet according the child’s age to reduce fever. NB: very high fever causes the child to jerk. Prolong jerking can cause damage to child’s brain Give three days’ treatment of ACT based on the weight or age of the child. ACT should not be given to infant below 4 months of age or less that 5 kg. Such cases should be referred. General Community Health Volunteers Training Facilitators’ Guide 38 Instruct the mother to return in 3rd days if no improvement, to return any time the condition get worse, to return if vomiting develops or continues. If the mother returns under the above condition, refer the child to the health facility Further instruction to the mother: 1) Give the medicine to the child regularly and according to the dosage 2) Continue to feed the child. Give more food than usual 3) Sponge if the child skin is ‘very hot’ 4) Give more fluid frequently.

Paracetamol 100 mg tablets-Dosage Age Group 2m-3 years 3-5 years ACT Weight in Kg 5-7 8-10 11-13 14-19 20-25 Dose 1tablet 2 tablets Age Blister packs 4-5m 6-11m 1-2 year 3-4 year 5-7 year Amodiaquine 50mg Day1 Day2 Day3 1/2 1/2 1/2 1/2 1/2 1/2 1 1 1 1.5 1.5 1.5 2 2 2 Artesunate---mg Day1 Day2 1/4 1/4 1/2 1/2 3/4 3/4 1 1 1.5 1.5 Day3 1/4 1/2 3/4 1 1.5 Evaluation: Role play to assess a child Role play to counsel a mother Case study1: A five month old infant brought by mother with history of fever for 2 days. No other reason for the fever: Diagnosis: malaria Treatment: See table above for correct doses of ACT What is the Instruction to mother? (See above) Case Study2; 2 month old infant was brought to gCHV with history of fever, vomiting and not sucking. Action to be taken: Sponge, give paracetamol and refer. Do not give ACT Case Study3 A five year child was rushed to gCHV. She has a history of high fever the previous night and is unconscious after convulsion. Action: Refer

immediately Case Study: 4 A four year old with history of fever and was treated with traditional herbs. Now he is 39 General Community Health Volunteers Training Facilitators Guide very weak and cannot talk but skin is ‘not hot’ Action: refer immediately Conduct drill exercise: Signs/ condition Severe weakness Mild fever, no other cause Convulsion/jerking Unable to suck for two days High fever, unable move extremities (5year old) 3 year old, fever and vomiting for two days 6m-High fever, ear running 8 m with fever, worse after 1 day Classification Danger sign Simple malaria Danger Danger sign Danger Danger sign Refer Refer Session 4: Prevention of Malaria Time: 3 hours Objective: At the end of the session, the participants will be able to: - Instruct mothers and other community members to use mosquito nets properly Describe mosquito breeding places to mother and community members. Motivate mother/other community members about clean environment on Training materials:

Training manual Classification card Stationery Malaria flip chart Visual aids Training Methodology: Brief review on malaria management Ask the participants to turn page of the manual. Ask 2-3 participants to read the points of the manual and lead the discussion on prevention of malaria Group discussion and presenting of group work on different ways of preventing malaria: proper use nets, getting rid of breeding places, maintenance of pit latrine, indoor residual spraying, clearing the bush around the yards Demonstration: Class to take short trip in the community to identify possible mosquito breeding place. Evaluation: General questions for the class. Session: 6 General Community Health Volunteers Training Facilitators’ Guide 40 Documentation-recording and reporting Time: 4 hours ARI- Facilitator Guide Training Schedule Session Morning Session 9.00 – 100 Afternoon Session 2.00 – 500 1st Day • Registration of the participants • Welcome and Introduction • Ground

rules setting • Role and Responsibility of gCHVs Session : 1 - Background information - ARI/Pneumonia - What is ARI? - Cough and Could - Where child with Pneumonia should be treated • • • • • Session:2 Review Cough and Could Pneumonia and Fast breathing Respiratory tract Respiratory rate in children 2nd Day 3rd Day Session: 3 Session:5 -Danger signs of - Counsel to Pneumonia/referral Mother condition - Assessment - Less than 2 practices using months old classification - 2 months to 5 card years old child. Break Session:4 - How to manage a child with cough and Cold - How to manage child with pneumonia - 3rd day follow-up Session:6 - Recording and Reporting practices - Closing. Role and Responsibilities of gCHVs:• Assess of Children 5 years of age for pneumonia using a timer. • Management of pneumonia for children 2 months to 5 years. • Refer of all 0- 2 month old cases. • Follow-up of treated and referral cases. • Counsel to mother about danger signs to look

for home care. • Recording and Reporting. Session 1: Acute respiratory infection. 41 General Community Health Volunteers Training Facilitators Guide Time: 2 hrs Topics to be covered in session one: 1. Back ground information on ARI/pneumonia 2. What is ARI? 3. Cough and Cold 4. Where child with pneumonia should be treated 5. Age groups Objectives: At the end of the session, participants should be able to:     Explain the problem of ARI in Liberia Describe cough and cold Explain where cough and cold can be treated describe the two age groups of children under five years Training Materials  Training manual  Photos of two and four year old children  Visual Aids (drawing of the Respiratory Track)  Classification Card Training Methodology  Introduce the topic  Ask participants to turn to page# 1  Ask participants to explain the picture/drawing on pages 1  Explain the meaning of ARI and why it is a big problem in Liberia  Describe ARI and

ensure participants understand by asking questions  Explain the age group and the difference in the respiration rate.  Have time for Ice breaker Evaluation: Ask each participant to explain cough and cold Let each participant tell where a child with pneumonia can be treated Let each participant describe the problem of ARI in Liberia Conduct drill exercise: Questions Answer ARI is big problem in Liberia Right ARI is not leading cause of death among wrong children in Liberia Cough and cold affect the throat only Wrong Cough and cold is a mild disease Right Cough and cold should treated only in HF Wrong gCHV can treat pneumonia Right HF can treat pneumonia Right Young infant means infant less than 2 months Right ‘Child’ means child 2 m-5 years Right Pneumonia is a severe disease Right It not treated pneumonia can kill the child Right Session 2: Signs and symptoms of cough and cold, and Pneumonia General Community Health Volunteers Training Facilitators’ Guide 42 Time: 4

hrs Topic to be covered: Cough and cold (running nose) Pneumonia/fast breathing Respiratory tract Respiratory rate in children Objectives At the end of this session, participants will be able to: a. describe signs and symptom of cough and cold b. Demonstrate and practice about use of timer c. describe signs and symptoms of Pneumonia d. Count the Respiration Rate using ARI Timer Training Materials  Training manual  Classification card  ARI Timer  Visual Aids (drawing of the Respiratory Track) Training Methodology  Introduce the topic  Ask participants to turn to page --- Ask participants to explain the picture/drawing on pages --- Describe ARI and ensure participants understand by asking questions  Explain the differences between Cough and Cold and Pneumonia  Explain the age group and the difference in the respiration rate (Reemphasis the less than 2 months age means, age of the child should be 1 month 29 days, not exactly 2months age). The number of breath

in one minute is called the breathing rate. The breathing rate for young infant is normally faster than for children.  Conduct drill exercise based on cut-off point of age group.  Provide one timer and demonstrate the methods of using timer to count respiratory rate.  Demonstrate the count of respiratory rate.  Let participants in return count of respiratory rate to each other.  Assure all participants count RR rate correctly.  Explain and demonstrate use of timer. - Take a timer - Press the middle part or circle of the timer - Listen to the ticking - Listen to half minutes sound one “beep” - Listen to the minute sound beep- beep - Start the timer again and listen to the ticking sound. - Stop the timer part way through the minute.  At the end review and reemphasize again to count correctly  Summarize and reemphasize the main points.  Have time for Ice breaker Evaluation 43 General Community Health Volunteers Training Facilitators Guide 1. 2. 3. 4. 5.

6. Ask participants to describe the respiratory tract Ask participants about the signs and symptoms of cough and cold Let each participant describe the signs and symptoms of Pneumonia Ask participants to show the difference between cough and cold and pneumonia Each should conduct respiration count (on each other) Conduct drill exercise on respiratory rate Questions Does this baby have fast Breathing Age Respiratory Rate 3 weeks 55 4 weeks 63 2 weeks 59 18 weeks 44 2 weeks 60 12 weeks 65 3 weeks 38 11 weeks 52 6 weeks 40 7 weeks 48 10 weeks 63 12 weeks 59 12 weeks 61 3 weeks 13 11 weeks 42 6 weeks 38 18 weeks 49 5 weeks 52 4 weeks 65 Answers No Yes No No Yes Yes No Yes No No Yes Yes Yes No No No No No Yes Trainers Notes Malaria What is malaria? How do we get malaria? What are the signs symptoms of malaria? How do we prevent malaria? How do we treat malaria? and Malaria is fever by history or touch (hotness of the skin). The anopheles mosquito is the only transmitter of malaria.

How do you know when a child has malaria? The child may have fever, loss of appetite, weakness, vomiting, headache, sweating, convulsions, paleness, dizziness, or other symptoms. Sleep under a treated bed net. Wire mesh on windows to keep mosquitoes out. ACT tablets. General Community Health Volunteers Training Facilitators’ Guide 44 Section 3: Danger signs of Pneumonia Time: 3 hours Objectives of the lesson At the end of this session participant should be able to: 1. List and describe the danger signs of Pneumonia 2. Describe procedure for referral? 3. Describe the danger signs of pneumonia in different age group Training materials  Training manual  Classification card  ARI Timer  Visual Aids (drawing of the Respiratory Track)  Referral forms  Pens, pencil eraser, sharpeners Training Methodology  Introduce the topic including the aim of the training  Ask participants to turn to page --- Ask participants to explain the picture/drawing on pages

----- Explain the meaning of danger signs of pneumonia. A danger sign means the child is very ill and needs referral to a health Facility. One danger sign of pneumonia is chest in drawing. Chest in drawing means that the lower chest wall goes in when child breath in.  Describe the danger signs and ensure participants understand by asking questions  Demonstrate how to determine fever or cold in the child  Describe the danger in different age group  Have time for Ice breaker Evaluation 45 General Community Health Volunteers Training Facilitators Guide 1. Ask participants why pneumonia is a big problem in Liberia 2. Ask participants to show the difference between cough and cold and pneumonia 3. Ask participants to state where pneumonia can be treated 4. Conduct drill exercise on Facilitators’ note: 1. The aim of the training is to reduce sickness and death due to pneumonia 2. This training will teach you how to reduce sickness and death due to pneumonia 3. Your job is

to provide care for all children under five years old with a cough, cold and pneumonia. Conduct the following drill exercise Signs Cold abdomen and extremities Not responding to sound Malnutrition in 6 yrs old child Less movement of the extremities In drawing chest 2months to 5 years child Not sucking or eating well. Very fever Classification Referral condition Referral condition Not comes in < 5 cases Referral condition Referral condition Referral condition Referral condition General Community Health Volunteers Training Facilitators’ Guide 46 Section 4: Management of ARI Time Frame: 4hrs Objectives At the end of this session, participants will be able to: - Treat for cough and cold - Treat Pneumonia - Prescribe Cotrimoxazole dose according to age group - Explain to mother when to return Training Materials  Training manual  Treatment card  Sample of drug  Dispensing bag  Tea spoon  A container with water  Materials for hand washing demonstration

Training Methodology  Introduce the topic  Ask participants to turn to page-- Ask participants to explain the picture/drawing on pages 1 & 2  Conduct drill exercise on age specific dose  Explain instruction to mother on the frequency and dose of the medication  Describe importance of 3rd day follow-up for reassessment of the child. Find out improvement of the child condition and methods of medication.  Describe the side effects and what to do in case of any side effects (Emphasis use of more fluid, breast feeding during medication.)  Role play  Have time for Ice breaker Evaluation o Ask participants to explain the difference between cough and cold, and pneumonia o Ask participant discuss cotrimoxazole doses Conduct drill exercise 47 General Community Health Volunteers Training Facilitators Guide Age of the child 2m 3m 4years 1year 5years 11 m 10 m 12 m 2 years 3 years Dose of cotromoxazole 1tab 2 tab 1 tab 2tabs 1 tab 2 tabs 2 tabs 2 tabs 1tabs

2tabs answers False False False False False True True False False False Session 5: Counsel to Mother Time: 3 hours Topic to be covered: Objectives: By the end of this session the participants will be able to: 1. counsel mothers/caretakers on management of cough and cold 2. Counsel mothers/care takers on management of pneumonia 3. Instruct mothers/ care takers on breast feeding 4. Instruct mothers/care takers to watch for danger signs for pneumonia 5. Instruct mother/caretaker on what to if the child has fever or is cold 6. Counsel mother on when to return to gCHV for referral Training Materials  Training manual  Treatment card  Sample of drug  Dispensing bag  Tea spoon  A container with water  Materials for hand washing demonstration Training Methodology  Introduce the topic  Ask participants to turn to page-- Explain the APAC principles in counseling: Ask, praise, advise and check  Explain to mother what to do if the child condition does not improve

 Ask participants to demonstrate counseling/role play  Describe the side effects and what to do in case of any side effects  Have time for Ice breaker Evaluation: Question and Answers General Community Health Volunteers Training Facilitators’ Guide 48 Session 6 Time: 4 hours Topic to cover: How to assess a child with ARI/Pneumonia, use of classification card for correct assessment, classification and management of cases. Practices or use of classification card in the group. The group can be divided into manageable size 4-6 for the group work. Each should be accompanied by a facilitator. Identify cases of cough and cold, pneumonia and cases of danger signs to the facilitator Objectives: At the end of the session, the participants should be able to use classification card and correctly classify and manage of <5 children with cough and could: • Assess a child with cough and cold • Assess a child with pneumonia • Identify the danger signs for Pneumonia •

Recording and Reporting Training materials required:  Training manual  Treatment card  Notebooks  Pencils  Wall chart of Recording form, classification card Training Methodology  Introduce the topic  Ask participants to turn to the classification cards  Briefly review the classification card  Explain the steps in assessing a child:  Case study for assessment and Recording reporting  Greet the mother respectively  Ask about the child (what is wrong with child)  Look: Observe the child (tell mother to remove clothes).  Check for fever, hypothermia, chest in-drawing, lethargy  Classify the finding 49 General Community Health Volunteers Training Facilitators Guide Each participant should be given the chance to assess the child with cough and cold and pneumonia and classify according to the classification card. There should be general discussions and final observations by the facilitators. Case study Case: 1 3 years old child with cough and

could RR Rate: 53 Chest In drawing: Present Case: 2 2 months old child RR Rate: 55 Case: 3 1month 15 days child RR Rate: 75 Chest indrawing: No Case: 4 6 months old child RR Rate: 49 Unable to drink or breast feed Case: 5 16 months old child RR Rate: 67 3rd day Follow-up: Yes RR in 3 rd day: 49 Add more exercises according to situation of the training program. General Community Health Volunteers Training Facilitators’ Guide 50 51 General Community Health Volunteers Training Facilitators Guide